|
HC Z E1 VNGD AS TIB BRG 18X67
|
Facility
OP
|
$7,525.04
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603482
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$6,998.29 |
| Rate for Payer: Aetna Commercial |
$6,351.13
|
| Rate for Payer: Aetna Medicare |
$2,483.26
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,483.26
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$4,321.63
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,703.90
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,855.75
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,731.59
|
| Rate for Payer: Cash Price |
$4,665.53
|
| Rate for Payer: Cash Price |
$4,665.53
|
| Rate for Payer: Centivo All Commercial |
$3,837.77
|
| Rate for Payer: Cigna All Commercial |
$6,494.11
|
| Rate for Payer: CORVEL All Commercial |
$6,998.29
|
| Rate for Payer: Coventry All Commercial |
$6,622.04
|
| Rate for Payer: Encore All Commercial |
$6,926.80
|
| Rate for Payer: Frontpath All Commercial |
$6,923.04
|
| Rate for Payer: Humana ChoiceCare |
$6,499.38
|
| Rate for Payer: Humana Medicare |
$3,837.77
|
| Rate for Payer: Lucent All Commercial |
$3,837.77
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,772.54
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$5,643.78
|
| Rate for Payer: PHP All Commercial |
$5,706.99
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,934.77
|
| Rate for Payer: Sagamore Health Network All Products |
$5,809.33
|
| Rate for Payer: Signature Care EPO |
$6,245.78
|
| Rate for Payer: Signature Care PPO |
$6,622.04
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$6,396.28
|
| Rate for Payer: United Healthcare Commercial |
$5,929.73
|
| Rate for Payer: United Healthcare Medicare |
$2,483.26
|
|
|
HC Z E1 VNGD PS+ TIB BRG 18 71/75
|
Facility
IP
|
$7,525.04
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603600
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,643.78 |
| Max. Negotiated Rate |
$6,998.29 |
| Rate for Payer: Aetna Commercial |
$6,501.63
|
| Rate for Payer: Cash Price |
$4,665.53
|
| Rate for Payer: Cigna All Commercial |
$6,494.11
|
| Rate for Payer: CORVEL All Commercial |
$6,998.29
|
| Rate for Payer: Coventry All Commercial |
$6,622.04
|
| Rate for Payer: Encore All Commercial |
$6,926.80
|
| Rate for Payer: Frontpath All Commercial |
$6,923.04
|
| Rate for Payer: Humana ChoiceCare |
$6,499.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,772.54
|
| Rate for Payer: PHCS All Commercial |
$5,643.78
|
| Rate for Payer: PHP All Commercial |
$5,706.99
|
| Rate for Payer: Sagamore Health Network All Products |
$5,809.33
|
| Rate for Payer: Signature Care EPO |
$6,245.78
|
| Rate for Payer: Signature Care PPO |
$6,622.04
|
| Rate for Payer: United Healthcare Commercial |
$5,929.73
|
|
|
HC Z E1 VNGD PS+ TIB BRG 18 71/75
|
Facility
OP
|
$7,525.04
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603600
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$6,998.29 |
| Rate for Payer: Aetna Commercial |
$6,351.13
|
| Rate for Payer: Aetna Medicare |
$2,483.26
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,483.26
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$4,321.63
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,703.90
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,855.75
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,731.59
|
| Rate for Payer: Cash Price |
$4,665.53
|
| Rate for Payer: Cash Price |
$4,665.53
|
| Rate for Payer: Centivo All Commercial |
$3,837.77
|
| Rate for Payer: Cigna All Commercial |
$6,494.11
|
| Rate for Payer: CORVEL All Commercial |
$6,998.29
|
| Rate for Payer: Coventry All Commercial |
$6,622.04
|
| Rate for Payer: Encore All Commercial |
$6,926.80
|
| Rate for Payer: Frontpath All Commercial |
$6,923.04
|
| Rate for Payer: Humana ChoiceCare |
$6,499.38
|
| Rate for Payer: Humana Medicare |
$3,837.77
|
| Rate for Payer: Lucent All Commercial |
$3,837.77
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,772.54
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$5,643.78
|
| Rate for Payer: PHP All Commercial |
$5,706.99
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,934.77
|
| Rate for Payer: Sagamore Health Network All Products |
$5,809.33
|
| Rate for Payer: Signature Care EPO |
$6,245.78
|
| Rate for Payer: Signature Care PPO |
$6,622.04
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$6,396.28
|
| Rate for Payer: United Healthcare Commercial |
$5,929.73
|
| Rate for Payer: United Healthcare Medicare |
$2,483.26
|
|
|
HC Z ECHO FIX FEM STEM 7X120 T1
|
Facility
IP
|
$3,477.60
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41603987
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,608.20 |
| Max. Negotiated Rate |
$3,234.17 |
| Rate for Payer: Aetna Commercial |
$3,004.65
|
| Rate for Payer: Cash Price |
$2,156.11
|
| Rate for Payer: Cigna All Commercial |
$3,001.17
|
| Rate for Payer: CORVEL All Commercial |
$3,234.17
|
| Rate for Payer: Coventry All Commercial |
$3,060.29
|
| Rate for Payer: Encore All Commercial |
$3,201.13
|
| Rate for Payer: Frontpath All Commercial |
$3,199.39
|
| Rate for Payer: Humana ChoiceCare |
$3,003.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,129.84
|
| Rate for Payer: PHCS All Commercial |
$2,608.20
|
| Rate for Payer: PHP All Commercial |
$2,637.41
|
| Rate for Payer: Sagamore Health Network All Products |
$2,684.71
|
| Rate for Payer: Signature Care EPO |
$2,886.41
|
| Rate for Payer: Signature Care PPO |
$3,060.29
|
| Rate for Payer: United Healthcare Commercial |
$2,740.35
|
|
|
HC Z ECHO FIX FEM STEM 7X120 T1
|
Facility
OP
|
$3,477.60
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41603987
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$3,234.17 |
| Rate for Payer: Aetna Commercial |
$2,935.09
|
| Rate for Payer: Aetna Medicare |
$1,147.61
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,147.61
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,997.19
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,173.85
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,319.75
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,262.37
|
| Rate for Payer: Cash Price |
$2,156.11
|
| Rate for Payer: Cash Price |
$2,156.11
|
| Rate for Payer: Centivo All Commercial |
$1,773.58
|
| Rate for Payer: Cigna All Commercial |
$3,001.17
|
| Rate for Payer: CORVEL All Commercial |
$3,234.17
|
| Rate for Payer: Coventry All Commercial |
$3,060.29
|
| Rate for Payer: Encore All Commercial |
$3,201.13
|
| Rate for Payer: Frontpath All Commercial |
$3,199.39
|
| Rate for Payer: Humana ChoiceCare |
$3,003.60
|
| Rate for Payer: Humana Medicare |
$1,773.58
|
| Rate for Payer: Lucent All Commercial |
$1,773.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,129.84
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$2,608.20
|
| Rate for Payer: PHP All Commercial |
$2,637.41
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,356.26
|
| Rate for Payer: Sagamore Health Network All Products |
$2,684.71
|
| Rate for Payer: Signature Care EPO |
$2,886.41
|
| Rate for Payer: Signature Care PPO |
$3,060.29
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,955.96
|
| Rate for Payer: United Healthcare Commercial |
$2,740.35
|
| Rate for Payer: United Healthcare Medicare |
$1,147.61
|
|
|
HC Z ECHO FX FEM STEM 13X150 T1
|
Facility
IP
|
$3,477.60
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41604386
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,608.20 |
| Max. Negotiated Rate |
$3,234.17 |
| Rate for Payer: Aetna Commercial |
$3,004.65
|
| Rate for Payer: Cash Price |
$2,156.11
|
| Rate for Payer: Cigna All Commercial |
$3,001.17
|
| Rate for Payer: CORVEL All Commercial |
$3,234.17
|
| Rate for Payer: Coventry All Commercial |
$3,060.29
|
| Rate for Payer: Encore All Commercial |
$3,201.13
|
| Rate for Payer: Frontpath All Commercial |
$3,199.39
|
| Rate for Payer: Humana ChoiceCare |
$3,003.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,129.84
|
| Rate for Payer: PHCS All Commercial |
$2,608.20
|
| Rate for Payer: PHP All Commercial |
$2,637.41
|
| Rate for Payer: Sagamore Health Network All Products |
$2,684.71
|
| Rate for Payer: Signature Care EPO |
$2,886.41
|
| Rate for Payer: Signature Care PPO |
$3,060.29
|
| Rate for Payer: United Healthcare Commercial |
$2,740.35
|
|
|
HC Z ECHO FX FEM STEM 13X150 T1
|
Facility
OP
|
$3,477.60
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41604386
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$3,234.17 |
| Rate for Payer: Aetna Commercial |
$2,935.09
|
| Rate for Payer: Aetna Medicare |
$1,147.61
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,147.61
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,997.19
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,173.85
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,319.75
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,262.37
|
| Rate for Payer: Cash Price |
$2,156.11
|
| Rate for Payer: Cash Price |
$2,156.11
|
| Rate for Payer: Centivo All Commercial |
$1,773.58
|
| Rate for Payer: Cigna All Commercial |
$3,001.17
|
| Rate for Payer: CORVEL All Commercial |
$3,234.17
|
| Rate for Payer: Coventry All Commercial |
$3,060.29
|
| Rate for Payer: Encore All Commercial |
$3,201.13
|
| Rate for Payer: Frontpath All Commercial |
$3,199.39
|
| Rate for Payer: Humana ChoiceCare |
$3,003.60
|
| Rate for Payer: Humana Medicare |
$1,773.58
|
| Rate for Payer: Lucent All Commercial |
$1,773.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,129.84
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$2,608.20
|
| Rate for Payer: PHP All Commercial |
$2,637.41
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,356.26
|
| Rate for Payer: Sagamore Health Network All Products |
$2,684.71
|
| Rate for Payer: Signature Care EPO |
$2,886.41
|
| Rate for Payer: Signature Care PPO |
$3,060.29
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,955.96
|
| Rate for Payer: United Healthcare Commercial |
$2,740.35
|
| Rate for Payer: United Healthcare Medicare |
$1,147.61
|
|
|
HC Z ECHO ILOK FEM STEM 11X140 T1
|
Facility
OP
|
$3,477.60
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41603991
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$3,234.17 |
| Rate for Payer: Aetna Commercial |
$2,935.09
|
| Rate for Payer: Aetna Medicare |
$1,147.61
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,147.61
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,997.19
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,173.85
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,319.75
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,262.37
|
| Rate for Payer: Cash Price |
$2,156.11
|
| Rate for Payer: Cash Price |
$2,156.11
|
| Rate for Payer: Centivo All Commercial |
$1,773.58
|
| Rate for Payer: Cigna All Commercial |
$3,001.17
|
| Rate for Payer: CORVEL All Commercial |
$3,234.17
|
| Rate for Payer: Coventry All Commercial |
$3,060.29
|
| Rate for Payer: Encore All Commercial |
$3,201.13
|
| Rate for Payer: Frontpath All Commercial |
$3,199.39
|
| Rate for Payer: Humana ChoiceCare |
$3,003.60
|
| Rate for Payer: Humana Medicare |
$1,773.58
|
| Rate for Payer: Lucent All Commercial |
$1,773.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,129.84
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$2,608.20
|
| Rate for Payer: PHP All Commercial |
$2,637.41
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,356.26
|
| Rate for Payer: Sagamore Health Network All Products |
$2,684.71
|
| Rate for Payer: Signature Care EPO |
$2,886.41
|
| Rate for Payer: Signature Care PPO |
$3,060.29
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,955.96
|
| Rate for Payer: United Healthcare Commercial |
$2,740.35
|
| Rate for Payer: United Healthcare Medicare |
$1,147.61
|
|
|
HC Z ECHO ILOK FEM STEM 11X140 T1
|
Facility
IP
|
$3,477.60
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41603991
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,608.20 |
| Max. Negotiated Rate |
$3,234.17 |
| Rate for Payer: Aetna Commercial |
$3,004.65
|
| Rate for Payer: Cash Price |
$2,156.11
|
| Rate for Payer: Cigna All Commercial |
$3,001.17
|
| Rate for Payer: CORVEL All Commercial |
$3,234.17
|
| Rate for Payer: Coventry All Commercial |
$3,060.29
|
| Rate for Payer: Encore All Commercial |
$3,201.13
|
| Rate for Payer: Frontpath All Commercial |
$3,199.39
|
| Rate for Payer: Humana ChoiceCare |
$3,003.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,129.84
|
| Rate for Payer: PHCS All Commercial |
$2,608.20
|
| Rate for Payer: PHP All Commercial |
$2,637.41
|
| Rate for Payer: Sagamore Health Network All Products |
$2,684.71
|
| Rate for Payer: Signature Care EPO |
$2,886.41
|
| Rate for Payer: Signature Care PPO |
$3,060.29
|
| Rate for Payer: United Healthcare Commercial |
$2,740.35
|
|
|
HC Z ECHO ILOK FEM STEM 9X130 T1
|
Facility
OP
|
$3,477.60
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41603720
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$3,234.17 |
| Rate for Payer: Aetna Commercial |
$2,935.09
|
| Rate for Payer: Aetna Medicare |
$1,147.61
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,147.61
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,997.19
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,173.85
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,319.75
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,262.37
|
| Rate for Payer: Cash Price |
$2,156.11
|
| Rate for Payer: Cash Price |
$2,156.11
|
| Rate for Payer: Centivo All Commercial |
$1,773.58
|
| Rate for Payer: Cigna All Commercial |
$3,001.17
|
| Rate for Payer: CORVEL All Commercial |
$3,234.17
|
| Rate for Payer: Coventry All Commercial |
$3,060.29
|
| Rate for Payer: Encore All Commercial |
$3,201.13
|
| Rate for Payer: Frontpath All Commercial |
$3,199.39
|
| Rate for Payer: Humana ChoiceCare |
$3,003.60
|
| Rate for Payer: Humana Medicare |
$1,773.58
|
| Rate for Payer: Lucent All Commercial |
$1,773.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,129.84
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$2,608.20
|
| Rate for Payer: PHP All Commercial |
$2,637.41
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,356.26
|
| Rate for Payer: Sagamore Health Network All Products |
$2,684.71
|
| Rate for Payer: Signature Care EPO |
$2,886.41
|
| Rate for Payer: Signature Care PPO |
$3,060.29
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,955.96
|
| Rate for Payer: United Healthcare Commercial |
$2,740.35
|
| Rate for Payer: United Healthcare Medicare |
$1,147.61
|
|
|
HC Z ECHO ILOK FEM STEM 9X130 T1
|
Facility
IP
|
$3,477.60
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41603720
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,608.20 |
| Max. Negotiated Rate |
$3,234.17 |
| Rate for Payer: Aetna Commercial |
$3,004.65
|
| Rate for Payer: Cash Price |
$2,156.11
|
| Rate for Payer: Cigna All Commercial |
$3,001.17
|
| Rate for Payer: CORVEL All Commercial |
$3,234.17
|
| Rate for Payer: Coventry All Commercial |
$3,060.29
|
| Rate for Payer: Encore All Commercial |
$3,201.13
|
| Rate for Payer: Frontpath All Commercial |
$3,199.39
|
| Rate for Payer: Humana ChoiceCare |
$3,003.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,129.84
|
| Rate for Payer: PHCS All Commercial |
$2,608.20
|
| Rate for Payer: PHP All Commercial |
$2,637.41
|
| Rate for Payer: Sagamore Health Network All Products |
$2,684.71
|
| Rate for Payer: Signature Care EPO |
$2,886.41
|
| Rate for Payer: Signature Care PPO |
$3,060.29
|
| Rate for Payer: United Healthcare Commercial |
$2,740.35
|
|
|
HC Z EI VNGD AS TIB BRG 12X79
|
Facility
IP
|
$7,525.04
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603594
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,643.78 |
| Max. Negotiated Rate |
$6,998.29 |
| Rate for Payer: Aetna Commercial |
$6,501.63
|
| Rate for Payer: Cash Price |
$4,665.53
|
| Rate for Payer: Cigna All Commercial |
$6,494.11
|
| Rate for Payer: CORVEL All Commercial |
$6,998.29
|
| Rate for Payer: Coventry All Commercial |
$6,622.04
|
| Rate for Payer: Encore All Commercial |
$6,926.80
|
| Rate for Payer: Frontpath All Commercial |
$6,923.04
|
| Rate for Payer: Humana ChoiceCare |
$6,499.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,772.54
|
| Rate for Payer: PHCS All Commercial |
$5,643.78
|
| Rate for Payer: PHP All Commercial |
$5,706.99
|
| Rate for Payer: Sagamore Health Network All Products |
$5,809.33
|
| Rate for Payer: Signature Care EPO |
$6,245.78
|
| Rate for Payer: Signature Care PPO |
$6,622.04
|
| Rate for Payer: United Healthcare Commercial |
$5,929.73
|
|
|
HC Z EI VNGD AS TIB BRG 12X79
|
Facility
OP
|
$7,525.04
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603594
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$6,998.29 |
| Rate for Payer: Aetna Commercial |
$6,351.13
|
| Rate for Payer: Aetna Medicare |
$2,483.26
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,483.26
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$4,321.63
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,703.90
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,855.75
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,731.59
|
| Rate for Payer: Cash Price |
$4,665.53
|
| Rate for Payer: Cash Price |
$4,665.53
|
| Rate for Payer: Centivo All Commercial |
$3,837.77
|
| Rate for Payer: Cigna All Commercial |
$6,494.11
|
| Rate for Payer: CORVEL All Commercial |
$6,998.29
|
| Rate for Payer: Coventry All Commercial |
$6,622.04
|
| Rate for Payer: Encore All Commercial |
$6,926.80
|
| Rate for Payer: Frontpath All Commercial |
$6,923.04
|
| Rate for Payer: Humana ChoiceCare |
$6,499.38
|
| Rate for Payer: Humana Medicare |
$3,837.77
|
| Rate for Payer: Lucent All Commercial |
$3,837.77
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,772.54
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$5,643.78
|
| Rate for Payer: PHP All Commercial |
$5,706.99
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,934.77
|
| Rate for Payer: Sagamore Health Network All Products |
$5,809.33
|
| Rate for Payer: Signature Care EPO |
$6,245.78
|
| Rate for Payer: Signature Care PPO |
$6,622.04
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$6,396.28
|
| Rate for Payer: United Healthcare Commercial |
$5,929.73
|
| Rate for Payer: United Healthcare Medicare |
$2,483.26
|
|
|
HC Z EI VNGD AS TIB BRG 14X79
|
Facility
IP
|
$7,525.04
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41603524
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,643.78 |
| Max. Negotiated Rate |
$6,998.29 |
| Rate for Payer: Aetna Commercial |
$6,501.63
|
| Rate for Payer: Cash Price |
$4,665.53
|
| Rate for Payer: Cigna All Commercial |
$6,494.11
|
| Rate for Payer: CORVEL All Commercial |
$6,998.29
|
| Rate for Payer: Coventry All Commercial |
$6,622.04
|
| Rate for Payer: Encore All Commercial |
$6,926.80
|
| Rate for Payer: Frontpath All Commercial |
$6,923.04
|
| Rate for Payer: Humana ChoiceCare |
$6,499.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,772.54
|
| Rate for Payer: PHCS All Commercial |
$5,643.78
|
| Rate for Payer: PHP All Commercial |
$5,706.99
|
| Rate for Payer: Sagamore Health Network All Products |
$5,809.33
|
| Rate for Payer: Signature Care EPO |
$6,245.78
|
| Rate for Payer: Signature Care PPO |
$6,622.04
|
| Rate for Payer: United Healthcare Commercial |
$5,929.73
|
|
|
HC Z EI VNGD AS TIB BRG 14X79
|
Facility
OP
|
$7,525.04
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41603524
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$6,998.29 |
| Rate for Payer: Aetna Commercial |
$6,351.13
|
| Rate for Payer: Aetna Medicare |
$2,483.26
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,483.26
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$4,321.63
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,703.90
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,855.75
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,731.59
|
| Rate for Payer: Cash Price |
$4,665.53
|
| Rate for Payer: Cash Price |
$4,665.53
|
| Rate for Payer: Centivo All Commercial |
$3,837.77
|
| Rate for Payer: Cigna All Commercial |
$6,494.11
|
| Rate for Payer: CORVEL All Commercial |
$6,998.29
|
| Rate for Payer: Coventry All Commercial |
$6,622.04
|
| Rate for Payer: Encore All Commercial |
$6,926.80
|
| Rate for Payer: Frontpath All Commercial |
$6,923.04
|
| Rate for Payer: Humana ChoiceCare |
$6,499.38
|
| Rate for Payer: Humana Medicare |
$3,837.77
|
| Rate for Payer: Lucent All Commercial |
$3,837.77
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,772.54
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$5,643.78
|
| Rate for Payer: PHP All Commercial |
$5,706.99
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,934.77
|
| Rate for Payer: Sagamore Health Network All Products |
$5,809.33
|
| Rate for Payer: Signature Care EPO |
$6,245.78
|
| Rate for Payer: Signature Care PPO |
$6,622.04
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$6,396.28
|
| Rate for Payer: United Healthcare Commercial |
$5,929.73
|
| Rate for Payer: United Healthcare Medicare |
$2,483.26
|
|
|
HC Z EI VNGD AS TIB BRG 18X71
|
Facility
OP
|
$7,525.04
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41603421
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$6,998.29 |
| Rate for Payer: Aetna Commercial |
$6,351.13
|
| Rate for Payer: Aetna Medicare |
$2,483.26
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,483.26
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$4,321.63
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,703.90
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,855.75
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,731.59
|
| Rate for Payer: Cash Price |
$4,665.53
|
| Rate for Payer: Cash Price |
$4,665.53
|
| Rate for Payer: Centivo All Commercial |
$3,837.77
|
| Rate for Payer: Cigna All Commercial |
$6,494.11
|
| Rate for Payer: CORVEL All Commercial |
$6,998.29
|
| Rate for Payer: Coventry All Commercial |
$6,622.04
|
| Rate for Payer: Encore All Commercial |
$6,926.80
|
| Rate for Payer: Frontpath All Commercial |
$6,923.04
|
| Rate for Payer: Humana ChoiceCare |
$6,499.38
|
| Rate for Payer: Humana Medicare |
$3,837.77
|
| Rate for Payer: Lucent All Commercial |
$3,837.77
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,772.54
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$5,643.78
|
| Rate for Payer: PHP All Commercial |
$5,706.99
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,934.77
|
| Rate for Payer: Sagamore Health Network All Products |
$5,809.33
|
| Rate for Payer: Signature Care EPO |
$6,245.78
|
| Rate for Payer: Signature Care PPO |
$6,622.04
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$6,396.28
|
| Rate for Payer: United Healthcare Commercial |
$5,929.73
|
| Rate for Payer: United Healthcare Medicare |
$2,483.26
|
|
|
HC Z EI VNGD AS TIB BRG 18X71
|
Facility
IP
|
$7,525.04
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41603421
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,643.78 |
| Max. Negotiated Rate |
$6,998.29 |
| Rate for Payer: Aetna Commercial |
$6,501.63
|
| Rate for Payer: Cash Price |
$4,665.53
|
| Rate for Payer: Cigna All Commercial |
$6,494.11
|
| Rate for Payer: CORVEL All Commercial |
$6,998.29
|
| Rate for Payer: Coventry All Commercial |
$6,622.04
|
| Rate for Payer: Encore All Commercial |
$6,926.80
|
| Rate for Payer: Frontpath All Commercial |
$6,923.04
|
| Rate for Payer: Humana ChoiceCare |
$6,499.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,772.54
|
| Rate for Payer: PHCS All Commercial |
$5,643.78
|
| Rate for Payer: PHP All Commercial |
$5,706.99
|
| Rate for Payer: Sagamore Health Network All Products |
$5,809.33
|
| Rate for Payer: Signature Care EPO |
$6,245.78
|
| Rate for Payer: Signature Care PPO |
$6,622.04
|
| Rate for Payer: United Healthcare Commercial |
$5,929.73
|
|
|
HC Z ENDO II HD 44
|
Facility
IP
|
$1,610.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41603988
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,207.50 |
| Max. Negotiated Rate |
$1,497.30 |
| Rate for Payer: Aetna Commercial |
$1,391.04
|
| Rate for Payer: Cash Price |
$998.20
|
| Rate for Payer: Cigna All Commercial |
$1,389.43
|
| Rate for Payer: CORVEL All Commercial |
$1,497.30
|
| Rate for Payer: Coventry All Commercial |
$1,416.80
|
| Rate for Payer: Encore All Commercial |
$1,482.00
|
| Rate for Payer: Frontpath All Commercial |
$1,481.20
|
| Rate for Payer: Humana ChoiceCare |
$1,390.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,449.00
|
| Rate for Payer: PHCS All Commercial |
$1,207.50
|
| Rate for Payer: PHP All Commercial |
$1,221.02
|
| Rate for Payer: Sagamore Health Network All Products |
$1,242.92
|
| Rate for Payer: Signature Care EPO |
$1,336.30
|
| Rate for Payer: Signature Care PPO |
$1,416.80
|
| Rate for Payer: United Healthcare Commercial |
$1,268.68
|
|
|
HC Z ENDO II HD 44
|
Facility
OP
|
$1,610.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41603988
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$1,497.30 |
| Rate for Payer: Aetna Commercial |
$1,358.84
|
| Rate for Payer: Aetna Medicare |
$531.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$531.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$924.62
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,006.41
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$611.00
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$584.43
|
| Rate for Payer: Cash Price |
$998.20
|
| Rate for Payer: Cash Price |
$998.20
|
| Rate for Payer: Centivo All Commercial |
$821.10
|
| Rate for Payer: Cigna All Commercial |
$1,389.43
|
| Rate for Payer: CORVEL All Commercial |
$1,497.30
|
| Rate for Payer: Coventry All Commercial |
$1,416.80
|
| Rate for Payer: Encore All Commercial |
$1,482.00
|
| Rate for Payer: Frontpath All Commercial |
$1,481.20
|
| Rate for Payer: Humana ChoiceCare |
$1,390.56
|
| Rate for Payer: Humana Medicare |
$821.10
|
| Rate for Payer: Lucent All Commercial |
$821.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,449.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,207.50
|
| Rate for Payer: PHP All Commercial |
$1,221.02
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$627.90
|
| Rate for Payer: Sagamore Health Network All Products |
$1,242.92
|
| Rate for Payer: Signature Care EPO |
$1,336.30
|
| Rate for Payer: Signature Care PPO |
$1,416.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,368.50
|
| Rate for Payer: United Healthcare Commercial |
$1,268.68
|
| Rate for Payer: United Healthcare Medicare |
$531.30
|
|
|
HC Z ENDO II HD 47
|
Facility
OP
|
$1,610.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41604384
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$1,497.30 |
| Rate for Payer: Aetna Commercial |
$1,358.84
|
| Rate for Payer: Aetna Medicare |
$531.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$531.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$924.62
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,006.41
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$611.00
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$584.43
|
| Rate for Payer: Cash Price |
$998.20
|
| Rate for Payer: Cash Price |
$998.20
|
| Rate for Payer: Centivo All Commercial |
$821.10
|
| Rate for Payer: Cigna All Commercial |
$1,389.43
|
| Rate for Payer: CORVEL All Commercial |
$1,497.30
|
| Rate for Payer: Coventry All Commercial |
$1,416.80
|
| Rate for Payer: Encore All Commercial |
$1,482.00
|
| Rate for Payer: Frontpath All Commercial |
$1,481.20
|
| Rate for Payer: Humana ChoiceCare |
$1,390.56
|
| Rate for Payer: Humana Medicare |
$821.10
|
| Rate for Payer: Lucent All Commercial |
$821.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,449.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,207.50
|
| Rate for Payer: PHP All Commercial |
$1,221.02
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$627.90
|
| Rate for Payer: Sagamore Health Network All Products |
$1,242.92
|
| Rate for Payer: Signature Care EPO |
$1,336.30
|
| Rate for Payer: Signature Care PPO |
$1,416.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,368.50
|
| Rate for Payer: United Healthcare Commercial |
$1,268.68
|
| Rate for Payer: United Healthcare Medicare |
$531.30
|
|
|
HC Z ENDO II HD 47
|
Facility
IP
|
$1,610.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41604384
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,207.50 |
| Max. Negotiated Rate |
$1,497.30 |
| Rate for Payer: Aetna Commercial |
$1,391.04
|
| Rate for Payer: Cash Price |
$998.20
|
| Rate for Payer: Cigna All Commercial |
$1,389.43
|
| Rate for Payer: CORVEL All Commercial |
$1,497.30
|
| Rate for Payer: Coventry All Commercial |
$1,416.80
|
| Rate for Payer: Encore All Commercial |
$1,482.00
|
| Rate for Payer: Frontpath All Commercial |
$1,481.20
|
| Rate for Payer: Humana ChoiceCare |
$1,390.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,449.00
|
| Rate for Payer: PHCS All Commercial |
$1,207.50
|
| Rate for Payer: PHP All Commercial |
$1,221.02
|
| Rate for Payer: Sagamore Health Network All Products |
$1,242.92
|
| Rate for Payer: Signature Care EPO |
$1,336.30
|
| Rate for Payer: Signature Care PPO |
$1,416.80
|
| Rate for Payer: United Healthcare Commercial |
$1,268.68
|
|
|
HC Z ENDO II HD 54
|
Facility
OP
|
$1,610.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41603719
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$1,497.30 |
| Rate for Payer: Aetna Commercial |
$1,358.84
|
| Rate for Payer: Aetna Medicare |
$531.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$531.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$924.62
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,006.41
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$611.00
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$584.43
|
| Rate for Payer: Cash Price |
$998.20
|
| Rate for Payer: Cash Price |
$998.20
|
| Rate for Payer: Centivo All Commercial |
$821.10
|
| Rate for Payer: Cigna All Commercial |
$1,389.43
|
| Rate for Payer: CORVEL All Commercial |
$1,497.30
|
| Rate for Payer: Coventry All Commercial |
$1,416.80
|
| Rate for Payer: Encore All Commercial |
$1,482.00
|
| Rate for Payer: Frontpath All Commercial |
$1,481.20
|
| Rate for Payer: Humana ChoiceCare |
$1,390.56
|
| Rate for Payer: Humana Medicare |
$821.10
|
| Rate for Payer: Lucent All Commercial |
$821.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,449.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,207.50
|
| Rate for Payer: PHP All Commercial |
$1,221.02
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$627.90
|
| Rate for Payer: Sagamore Health Network All Products |
$1,242.92
|
| Rate for Payer: Signature Care EPO |
$1,336.30
|
| Rate for Payer: Signature Care PPO |
$1,416.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,368.50
|
| Rate for Payer: United Healthcare Commercial |
$1,268.68
|
| Rate for Payer: United Healthcare Medicare |
$531.30
|
|
|
HC Z ENDO II HD 54
|
Facility
IP
|
$1,610.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41603719
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,207.50 |
| Max. Negotiated Rate |
$1,497.30 |
| Rate for Payer: Aetna Commercial |
$1,391.04
|
| Rate for Payer: Cash Price |
$998.20
|
| Rate for Payer: Cigna All Commercial |
$1,389.43
|
| Rate for Payer: CORVEL All Commercial |
$1,497.30
|
| Rate for Payer: Coventry All Commercial |
$1,416.80
|
| Rate for Payer: Encore All Commercial |
$1,482.00
|
| Rate for Payer: Frontpath All Commercial |
$1,481.20
|
| Rate for Payer: Humana ChoiceCare |
$1,390.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,449.00
|
| Rate for Payer: PHCS All Commercial |
$1,207.50
|
| Rate for Payer: PHP All Commercial |
$1,221.02
|
| Rate for Payer: Sagamore Health Network All Products |
$1,242.92
|
| Rate for Payer: Signature Care EPO |
$1,336.30
|
| Rate for Payer: Signature Care PPO |
$1,416.80
|
| Rate for Payer: United Healthcare Commercial |
$1,268.68
|
|
|
HC Z ENDO II MOD HD 48
|
Facility
IP
|
$1,610.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41603986
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,207.50 |
| Max. Negotiated Rate |
$1,497.30 |
| Rate for Payer: Aetna Commercial |
$1,391.04
|
| Rate for Payer: Cash Price |
$998.20
|
| Rate for Payer: Cigna All Commercial |
$1,389.43
|
| Rate for Payer: CORVEL All Commercial |
$1,497.30
|
| Rate for Payer: Coventry All Commercial |
$1,416.80
|
| Rate for Payer: Encore All Commercial |
$1,482.00
|
| Rate for Payer: Frontpath All Commercial |
$1,481.20
|
| Rate for Payer: Humana ChoiceCare |
$1,390.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,449.00
|
| Rate for Payer: PHCS All Commercial |
$1,207.50
|
| Rate for Payer: PHP All Commercial |
$1,221.02
|
| Rate for Payer: Sagamore Health Network All Products |
$1,242.92
|
| Rate for Payer: Signature Care EPO |
$1,336.30
|
| Rate for Payer: Signature Care PPO |
$1,416.80
|
| Rate for Payer: United Healthcare Commercial |
$1,268.68
|
|
|
HC Z ENDO II MOD HD 48
|
Facility
OP
|
$1,610.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41603986
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$1,497.30 |
| Rate for Payer: Aetna Commercial |
$1,358.84
|
| Rate for Payer: Aetna Medicare |
$531.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$531.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$924.62
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,006.41
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$611.00
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$584.43
|
| Rate for Payer: Cash Price |
$998.20
|
| Rate for Payer: Cash Price |
$998.20
|
| Rate for Payer: Centivo All Commercial |
$821.10
|
| Rate for Payer: Cigna All Commercial |
$1,389.43
|
| Rate for Payer: CORVEL All Commercial |
$1,497.30
|
| Rate for Payer: Coventry All Commercial |
$1,416.80
|
| Rate for Payer: Encore All Commercial |
$1,482.00
|
| Rate for Payer: Frontpath All Commercial |
$1,481.20
|
| Rate for Payer: Humana ChoiceCare |
$1,390.56
|
| Rate for Payer: Humana Medicare |
$821.10
|
| Rate for Payer: Lucent All Commercial |
$821.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,449.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,207.50
|
| Rate for Payer: PHP All Commercial |
$1,221.02
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$627.90
|
| Rate for Payer: Sagamore Health Network All Products |
$1,242.92
|
| Rate for Payer: Signature Care EPO |
$1,336.30
|
| Rate for Payer: Signature Care PPO |
$1,416.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,368.50
|
| Rate for Payer: United Healthcare Commercial |
$1,268.68
|
| Rate for Payer: United Healthcare Medicare |
$531.30
|
|
